Articaine, 40 ml/ml 1.7 ml cartridge 50 pcs.

Articaine is a local anesthetic (thiophene derivative) for infiltration and conduction anesthesia in dental practice, has a pronounced local anesthetic effect. In tissues (in low-alkaline environment) it undergoes hydrolysis and releases base, which has lipophilic properties and easily penetrates through the membrane into the nerve fiber.

Articaine interacts with the receptors and blocks the sodium channels in the nerve fiber membrane, thus providing a local anesthetic effect.

The action of the drug starts quickly (latency period is 1-3 minutes). The duration of action is 20 minutes. Rapid destruction of articaine to inactive metabolite – articic acid – is the reason of its very low toxicity, which allows repeated administration of the drug. In an acidic environment the effect is reduced.

Indications

Infiltration and conduction anesthesia in dentistry.

Active ingredient

Composition

Injection solution is clear, colorless or with a yellowish tint.

1 ml articaine hydrochloride 40 mg

Associated substances: sodium chloride – 2.1 mg, water d/i up to 1 ml.

How to take, the dosage

It is always advisable to perform an aspiration test before administering the drug in order to avoid intravascular injection of the drug. The plunger pressure during drug administration should be adjusted according to the tissue sensitivity. Injection of the drug into inflamed areas of the mucosa is not recommended. Food intake is allowed only after recovery of sensitivity.

In case of uncomplicated extraction of the upper jaw teeth in the non-inflammatory stage – in the vestibular depot 1.7 ml per tooth; if necessary additional 1.0-1.7 ml. For anesthesia for palatal incisions and sutures to create a palatal depot – 0.1 ml. In the removal of mandibular premolars (5-5) in the uncomplicated stage, infiltration anesthesia gives the effect of conductive anesthesia. When preparation of cavities and teeth for crowns, with the exception of mandibular molars – vestibular injection of 0.5-1.7 ml per tooth.

In a single treatment procedure, the maximum dose for adults is 4 mg/kg body weight.

Interaction

Topical anesthetics increase the effect of drugs that depress the central nervous system.

In concomitant use:

– anticoagulants (sodium ardeparin, sodium dalteparin, sodium danaparoid, sodium enoxaparin, heparin, warfarin) increase the risk of hemorrhage and bleeding;

– monoamine oxidase inhibitors (MAO) (furazolidone, procarbazine, selegiline) increase the risk of arterial hypotension (MAO inhibitors must be stopped 10 days before the local anesthetic);

– the effects of muscle relaxants are intensified and prolonged;

additive effect with narcotic analgesics; increased respiratory depression;

– vasoconstrictors enhance and prolong the local anesthetic effect of articaine;

– cholinesterase inhibitors (antimiasthenics, demecaria bromide, ecothiopate chloride), cyclophosphamide, thiotepa reduce the metabolism of articaine.

Articaine exhibits antagonism with anti-myasthenic agents in its effect on the skeletal musculature, especially when used in high doses, which requires additional correction of myasthenia gravis treatment.

The treatment of the local anesthetic injection site with disinfectant solutions containing heavy metals increases the risk of a local reaction in the form of painful sensitivity, edema.

The metabolite of procaine (para-aminobenzoic acid) is an antagonist of antimicrobial sulfonamides.

Special Instructions

It should not be injected intravenously!

The injection should not be given in the area of inflammation.

In order to prevent infections (including hepatitis), care must be taken to ensure that new sterile syringes and needles are always used each time a solution is drawn from the ampoule. Opened cartridges must not be used again for other patients.

In the removal of mandibular premolars in the uncomplicated stage, infiltration anesthesia has the effect of guiding anesthesia. Infiltration mandibular anesthesia of the tongue and soft palate is ineffective – conduction anesthesia is required.

Patients require monitoring of cardiovascular, respiratory and central nervous system function.

MAO inhibitors should be discontinued 10 days prior to administration of the local anesthetic.

Influence on the ability to drive vehicles and engage in potentially hazardous activities

At the time of treatment, caution should be exercised when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and rapid psychomotor reactions.

Per pediatric use

The efficacy and safety of the drug in children under 4 years of age have not been studied, so its administration is contraindicated.

Contraindications

– hypersensitivity to articaine or other local anesthetic drugs of the amide group;

– megaloblastic B12-deficiency anemia;

– closed-angle glaucoma;

– CNS diseases;

– chronic hypoxia;

– bronchial asthma;

– paroxysmal tachycardia;

– atrial fibrillation;

– severe cardiac conduction abnormalities (e.g., atrioventricular block of degree II-III, severe bradycardia);

– acute heart failure;

– arterial hypotension;

– voluminous maxillofacial surgeries and when the duration of intervention exceeds 20 minutes;

– children under 4 years of age (effectiveness and safety have not been studied).

With caution

Pregnant women with pre-eclampsia, bleeding in the last trimester of pregnancy.

Side effects

The drug is usually well tolerated by patients, however, the following side effects may occur:

Central and peripheral nervous system (dose-dependent):stupor, sometimes progressing to loss of consciousness, respiratory distress, sometimes progressing to respiratory arrest, muscle tremor, muscle twitching sometimes progressing to generalized convulsions.

Non-dose-dependent – dizziness, paresthesias, hypoesthesia.

Sometimes if the correct injection technique is not followed correctly when administering a local anesthetic in dental practice, nerve damage is possible, particularly in these cases, facial nerve damage may occur, which can lead to facial nerve paralysis.

On the visual organ: transient visual disturbances (blurred vision, blindness, double vision) occurring during or shortly after the injection of the local anesthetic agent.

Cardiovascular disorders: decreased blood pressure, heart failure and shock.

Digestive system disorders:nausea, vomiting.

From the immune system:allergic reactions. At the injection site they may manifest as swelling or inflammation of the mucous membrane. Skin hyperemia, conjunctivitis, rhinitis and angioedema may be unrelated to the injection site. Angioedema may manifest as swelling of the upper and/or lower lips, cheeks, swelling of the vocal cords with a “lump in the throat” sensation and difficulty in swallowing, hives and difficulty in breathing. Any of these manifestations can progress to anaphylactic shock.

Overdose

Symptoms:dizziness, motor agitation or stupor during injection, loss of consciousness, decreased blood pressure, bradycardia.

Treatment:At the first signs of overdose, the injection should be stopped immediately and the patient should be placed horizontally, airway clearance, heart rate and blood pressure monitored. In dyspnea, apnea – oxygen, endotracheal intubation, artificial lung ventilation (central analeptics are contraindicated); in convulsions – intravenous short-acting barbiturates slowly with simultaneous oxygen supply and hemodynamic control; in severe circulatory disorders and shock – intravenous infusion of electrolytes, glucocorticosteroids, plasma substitutes, albumin; in collapse and increasing bradycardia – intravenous slow epinephrine (adrenaline) 0.1 mg, then intravenous drip with control of heart rate and blood pressure; in severe tachycardia and tachyarrhythmia – intravenous beta-adrenoblockers. Oxygen supply and blood circulation control are necessary in all cases.